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multiple 99292 denial to Mcare

  1. Default multiple 99292 denial to Mcare
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    Hello-
    I could really use some guidance here. Medicare has denied billings with multiple 99292 codes (billed w/ 99291) stating that they are duplicates.

    Patient meets all criteria for critical codes, was seen X 155 minutes, by one physician.

    Medicare states that I need to add a modifier that signifies this is not duplicated services.

    What do they want?

    TIA - BC

  2. Default
    Does anyone bill multiple 99292's ? Do you bill them to Medicare? Please tell me if you add a modifier to them so they aren't denied as "duplicates".

    Thank you

  3. #3
    Location
    Milwaukee WI
    Posts
    4,466
    Default How - EXACTLY - did you bill it?
    Might help if we knew EXACTLY how you submitted the claim?

    Could be all they want is the documentation to prove the length of time spent in critical care.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  4. #4
    Location
    Maryville
    Posts
    17
    Default
    Are you billing in multiple units?

    I work for a group of critical care physicians, this is the way we would bill these services:

    Example: 155 minutes
    99291-25
    99292 x 3 units of service

    Hope this helps!
    Kim Pizzo, CPC,CPMA

  5. Default
    Quote Originally Posted by 13kpcpc View Post
    Are you billing in multiple units?

    I work for a group of critical care physicians, this is the way we would bill these services:

    Example: 155 minutes
    99291-25
    99292 x 3 units of service

    Hope this helps!
    Kim Pizzo, CPC,CPMA
    Thank you Kim - no, I'm currently not using units and I will try that. In the past, units were not accepted but things change.

    I appreciate your help.

  6. Default
    Quote Originally Posted by FTessaBartels View Post
    Might help if we knew EXACTLY how you submitted the claim?

    Could be all they want is the documentation to prove the length of time spent in critical care.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC
    Not sure what you mean by exactly but here goes;
    I send the claims electonically
    On a single claim there's 99291 and 2 99292s each on a separate line.
    They have not been denied for documentation.

    Medicare states, "you've excluded the correct modifier" (actual quote)
    No other services/procedures were included

    Thank you for your response

  7. #7
    Location
    Baton Rouge
    Posts
    1,239
    Default
    Quote Originally Posted by BarCode View Post
    Not sure what you mean by exactly but here goes;
    I send the claims electonically
    On a single claim there's 99291 and 2 99292s each on a separate line.
    They have not been denied for documentation.

    Medicare states, "you've excluded the correct modifier" (actual quote)
    No other services/procedures were included

    Thank you for your response
    If your MAC doesn't allow units for this code, and you are putting it on separate lines, they are probably looking for a modifier 59; your claim would be:

    99291
    99292
    99292-59


    Or like someone above said, put 99292 with 2 units if that would be allowed. I believe ours does; might be worth a shot.

    Hope this helps!
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

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